Technology, work and information flow: Lessons from the implementation of a wireless alert pager system
Reddy MC, McDonald DW, Pratt W, Shabot MM. Technology, work and information flow: Lessons from the implementation of a wireless alert pager system. J Biomed Informatics. 2005; 38. 229-238.
Introduction: The authors examined the effect of introduction of a new technology on information flow in the hospital setting by studying the adoption a wireless alert pager system. Introduction of such technology can assist in delivering information to decision makers in a more timely fashion. However, there can be unintended consequences in terms of work practices and information flow. This article examined the impact on a care team consisting of residents and attending physicians, as well as the impact on the role of nursing in information flow.
Background: The introduction of an alphanumeric paging alert system into a Surgical Intensive Care Unit (SICU) at a teaching hospital was studied. The system allowed real time notification of critical lab results, medication problems and critical patient trends. Users studied included surgical residents, fellows, and attending physicians, all of whom had been using the system for at least 3 months. SICU nurses, though not using the system, were also studied to examine the effects on their work flow. Qualitative methods were used, including formal semi-structured interviews and observations.
Findings: Overall users were satisfied with the system and felt it helped them make decisions more quickly. Several challenges were identified. First was loss of hierarchical context, with alerts going to residents, fellow, and attendings simultaneously, rather than just to the resident, who could resolve the issue or elevate as needed. A second challenge is the unidirectional flow of the paging system, which precludes immediate issuance of orders or calls for more information to make a decision, as well as communication to the attending that the problem is resolved. A third challenge is information overload, as there is no mechanism for filtering or prioritizing alerts or directing them only to the appropriate level. Finally, there was disruption of organizational roles, with nurses reluctant to cede the role of notifying physicians for fear that critical results would be missed or that collaborative care would not continue to occur.
Discussion: Some of the problems identified could be solved through refinement of the technology in use, particularly through use of two-way pagers and alert records, which would provide feedback that results had been received, and allow sequential notification if the first person paged did not receive the message. However, these technological solutions do not address the nursing concerns regarding loss of collaboration and context for information, nor the responsibility the nurses have for ensuring the physicians are informed.
Conclusion: This paging system, though widely accepted by the users, did introduce some challenges in terms of disruptions of traditional work and information flow. This highlights the importance of understanding the work that healthcare providers do and the needs they have when introducing new technologies. Although they may resolve problems, they may also introduce new problems which could potentially be avoided by examining how the new technology will fit into the workflow and address those needs.